Quality of Life after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Prospective Multicenter Cohort Study

Abstract

Background/AimsEndoscopic submucosal dissection (ESD) has been an established treatment for indicated early gastric cancer (EGC) without deterioration of quality of life (QOL) compared with surgical resection. The aim of this study was to evaluate long-term QOL in patients undergoing ESD for EGC.MethodsPatients scheduled to undergo curative ESD for EGC were prospectively enrolled from 12 institutions between May 2010 and December 2011. Assessments of QOL with Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire-core (QLQ-C30) and a gastric cancer-specific questionnaire (STO22) were performed at baseline and at 7 days, 3 months, and 6 months after ESD.ResultsA total of 666 subjects were assessed for QLQ-C30 and QLQ-STO22. The mean QLQ-C30 score was 69.5 at baseline, 68.8 at 7 days, 73.1 at 3 months, and 73.2 at 6 months. The global health status on the EORTC QLQ-C30 was significantly improved after 3 and 6 months (p=0.0003 and p<0.0001, respectively). The QLQ-C30 and STO22 scores were not significantly different, or they only slightly deteriorated between before and immediately after ESD, but they were significantly improved after 3 and 6 months (p<0.05).ConclusionsQOL did not deteriorate immediately after ESD, and it improved more significantly at up to 6 months in patients who underwent curative ESD for EGC without significant complications.

Risk Factors and Clinical Outcomes of Non-Curative Resection in Patients with Early Gastric Cancer Treated with Endoscopic Submucosal Dissection: A Retrospective Multicenter Study in Korea

“…At present, endoscopic submucosal dissection (ESD) is accepted as a standard treatment for gastric cancer in patients with a negligible risk of lymph node or distant metastasis. [6][7][8][9] Endoscopic resection of EGC is indicated on the basis of tumor differentiation, size, ulceration, and invasion depth, and its goal is "curative resection" (CR). 10 In cases of non-curative resection (NCR), additional treatment is needed because of local recurrence and lymph node metastasis, for which the standard treatment is gastrectomy with lymphadenectomy.…”

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

“…Studies have compared the long‐term outcomes of ESD and surgery for EGC . Compared with those undergoing surgery, including subtotal or total gastrectomy, patients undergoing ESD had less frequecies of fatigue, nausea/vomiting, appetite loss, diarrhea, pain, reflux symptoms, eating restrictions, anxiety, taste impairment, or poor body image, as measured by the Short‐form Health Survey and the European Organization for Research and Treatment of Cancer Quality of Life questionnaires . Moreover, compared with surgery, patients treated with ESD had shorter hospital stay, lower medical costs and fewer procedure‐related complications .…”

Survival and Quality of Life in Patients Gastrectomized by Gastric Cancer

“…La sobrevida en pacientes con cáncer gástrico llega al 90% a los 5 años, es aceptado que tres factores inciden en la sobrevida, 1) si es mucoso o submucoso, 2) si presenta compromiso linfático, aceptándose que es el factor pronostico más importante, y 3) el tipo histológico, aunque según estudios chilenos no se encuentra una diferencia significativa según el tipo histológico, a diferencia de los estudios japoneses y mejicanos en los que la histología del tumor relacionan a una diferencia importante en la sobrevida global del paciente (5,8,12) . La sobrevida promedio a los 5 años es de 88%, a los 60 meses la supervivencia en el cáncer mucoso fue de 92% y el submucoso 72%, según el estudio chileno de seguimiento a 44 años, hasta los 15 años hubo 35 fallecidos de los cuales 24 fueron no relacionadas a la patología y solo el 11% se relacionaron a recurrencia ganglionar o hepática, en cambio según un estudio mejicano la sobrevida a los 5 años es de 54% en pacientes con ganglios positivos al momento de la cirugía (8,13) .…”

“…Macroscópicamente el cáncer gástrico se clasifica en lesiones incipientes y avanzadas, definiéndose como incipiente a la neoplasia limitada a la mucosa o submucosa, independientemente de las metástasis a ganglios u otros órganos, también se le conoce como cáncer gástrico precoz. En países occidentales se diagnostica en este estadio hasta el 24% en comparación con el Japón en el que llega al 46% (5) .…”